We must think outside the box to understand nonadherence.

摘要

Last month, a 3-year-old girl presented to our clinic with refractory eczema despite treatment with what should have been a highly effective regimen of topical triamcinolone to the body, desonide and tacrolimus for the face, and fluocinonide to the worst areas. This failure was due not to T-cells resistant to all these medications but surely to poor adherence. Adherence is a complicated problem that incorporates a multitude of intertwined variables, and we do not fully understand why patients do not use their medications as recommended. The survey of self-reported reasons for poor adherence by Ellis et al and a previous study by Brown et al provide some of the reasons (1), but certain limitations of survey methodologies should be considered. Ellis et al's survey asked subjects a breadth of questions but, by nature of study design, asked only questions that the investigators perceived to be important. This methodology does not explore unknown factors, and perhaps first conducting an open-ended qualitative study would have identified concepts not obvious to the investigators. We should not assume that, from the physicians' compartment, we have complete insight into what patients do or think in theirs.